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NPI Code Detail

MEDICARE: SCENIC WAY LLC

MEDICARE: SCENIC WAY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician
2363A00000XPhysician Assistant
3363L00000XNurse Practitioner
4208M00000XHospitalist Physician

General Provider Information

NPI Number : 1952175127
Entity Type Code : Organization
Provider Name (Legal Business Name) : SCENIC WAY LLC
Provider Business Mailing Address
First Line : PO BOX 1249
Second Line :
City : BOUNTIFUL
State : UT
Zip : 84011-1249
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4252 S BIRKHILL BLVD
Second Line :
City : MURRAY
State : UT
Zip : 84107-5715
Country : US
Telephone Number : 385-425-0050
Fax Number : 801-296-1715
Authorized Official
Title or Position : OWNER
Name : KIRSTEN NOVAK
Credential :
Telephone Number : 801-951-2351
Provider Enumeration Date : 11/08/2023
Last Update Date : 06/24/2024

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Directions to “SCENIC WAY LLC ” Practice Location

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